Remote-Eligible Managed Care Pharmacy Tech

Univera Healthcare; Buffalo (NY); Remote; USD 29,000 - 46,000; Full time

Benefits offered by this job

Group health

Dental insurance

Retirement plan

Wellness program

Paid time off

Job summary

Univera Healthcare is seeking a Managed Care Pharmacy Technician in Buffalo, NY to administer member and client programs optimizing pharmacy benefits and the prescription process. You will handle live calls to members, physicians, and pharmacists, and support prior authorization activities under a licensed pharmacist.

The role involves data entry, real-time authorization, formulary management, and collaboration with the Pharmacy Benefits Team.

Qualifications

• High school diploma with a minimum of two years’ experience in health-related field is required.
• Pharmacy Technician certification (CPhT), LPN, Medical Assistant/Technologist background strongly preferred.
• Basic understanding and interpretation of medical terminology and diagnosis codes required.
• Basic understanding of drug classes and therapeutic interchange as described in the drug policies.
• A clear understanding of prescription and medical benefits as it applies to the utilization review process.
• Must demonstrate proficient experience with the Microsoft Office suite.
• Strong verbal and written communication skills are required.
• Must possess a high degree of professionalism, strong work ethic and the ability to maintain a positive attitude when working with internal and external customers.
• Must be conscientious, efficient and accurate in prior authorization, exception and medical/Rx necessity review processing.
• Continually strive to develop and/or refine skills necessary to respond to customers.
• Must possess strong customer service orientation and the ability to interface effectively with internal and external customers.
• Capable of working independently and applying problem solving and analytical abilities.
• Ability to cover rotating on-call responsibilities, as well as a late shift on Fridays.
• Ability to work additional hours as needed in order to meet turnaround time responsibilities.

Responsibilities

• Review medical exception requests based on algorithms created by pharmacists.
• Review clinical documentation against applicable criteria submitted by physicians and pharmacists to determine approval of request for prior authorization.
• Assist with data entry and monitoring/researching member profiles for prior authorization requests and ad hoc reports.
• Provide information via telephone to physicians and pharmacists regarding questions concerning initiatives involving member prescriptions.
• Provide real time authorization certification of requests for prescription medications for vacation supplies, duplication of therapy overrides, medication synchronization requests and package size issues.
• Implement formulary utilization management tools (i.e. prior authorization, quantity limits, step therapy, dose optimization, age/gender restrictions)
• Work with internal and external customers to identify, analyze and solve difficult situations including system issues relative to the Pharmacy benefit.
• Research and resolve issues related to mail-order service, specialty pharmacy, or pharmacy claims processed in the Facets system at the Plan.
• Provide backup coverage to Pharmacy Benefits Team for the pharmacy phone queue line as needed, to assist in providing service to internal departments, external practitioners and pharmacists calling with questions and/or problems pertaining to the pharmacy benefit.
• Monitor and troubleshoot the Pharmacy Benefit Management (PBM) and other pharmacy interfaces for eligibility, claims, and formulary issues. Conduct testing of the interfaces as necessary.
• Monitor production and quality improvement. Work with management and staff to ensure quality effort that supports the Pharmacy department standards. In conjunction with the supervisor, establish productivity and quality standards.
• Attend staff meetings and in-service programs as requested.
• Perform rotating on-call responsibilities including holidays/evenings.
• Work additional hours as needed in order to meet turnaround time responsibilities.
• The employee agrees to comply with CDPHP’s Corporate Compliance Policy and all laws, rules, regulations and standards of conduct relating to the Corporate Compliance Policy and has a duty and obligation to report any suspected violations of any law, the standards of conduct or Corporate Compliance Policy to his or her immediate Supervisor, the fraud and abuse hotline, the Compliance Officer, the Compliance Director, Human Capital Management or the Chief Executive Officer.
• Perform other duties as assigned.

Skills

Pharmacy experience

CPhT certification

Medical terminology

Microsoft Office

Customer service

Data entry

Education

High school diploma

Associates degree preferred

Tools

Facets system

Job description

Univera Healthcare is seeking a Managed Care Pharmacy Technician in Buffalo, NY to administer member and client programs optimizing pharmacy benefits and the prescription process. You will handle live calls to members, physicians, and pharmacists, and support prior authorization activities under a licensed pharmacist.

The role involves data entry, real-time authorization, formulary management, and collaboration with the Pharmacy Benefits Team.